LB 10 Preliminary Results of a Healthcare-Associated Infection and Antimicrobial Use Prevalence Survey in 22 U.S. Acute Care Hospitals

Sunday, April 3, 2011: 2:30 PM
Coronado BCD (Hilton Anatole)
Shelley S. Magill, MD, PhD , Centers for Disease Control and Prevention, Atlanta, GA
Laura M. Mcallister, MPH , Centers for Disease Control and Prevention, Atlanta, GA
Kathy Allen-Bridson, RN, BSN, CIC , Centers for Disease Control and Prevention, Atlanta, GA
Wendy Bamberg, MD , Colorado Department of Public Health and Environment, Denver, CO
Joan Baumbach, MD, MS, MPH , New Mexico Department of Health, Santa Fe, NM
Zintars Beldavs, MS , Oregon Department of Human Services, Portland, OR
Cathy Concannon , University of Rochester, Rochester, NY
Matthew B. Crist, MD, MPH , Tennessee Department of Health, Nashville, TN
Ghinwa Dumyati, MD , University of Rochester, Rochester, NY
Julie Duran, MPH , Colorado Department of Public Health and Environment, Denver, CO
Jonathan Edwards, MStat , Centers for Disease Control and Prevention, Atlanta, GA
Deborah Godine, RN, CIC , California Emerging Infections Program, Oakland, CA
Jane E. Harper, BSN, MS, CIC , Minnesota Department of Health, Saint Paul, MN
Katherine Henry, MPH , Maryland Department of Health and Mental Hygiene, Baltimore, MD
Teresa Horan, MPH, CIC , Centers for Disease Control and Prevention, Atlanta, GA
Marion A. Kainer, MBBS, MPH , Tennessee Department of Health, Nashville, TN
Patricia Lawson, RN, MS, MPH, CIC , Maryland Department of Health and Mental Hygiene, Baltimore, MD
Ruth Lynfield, MD , Minnesota Department of Health, Saint Paul, MN
Monear Makvandi, MPH , New Mexico Department of Health, Santa Fe, NM
Richard Melchreit, MD , Connecticut Department of Public Health, Hartford, CT
Gloria Morrell, MSN, RN , Centers for Disease Control and Prevention, Atlanta, GA
Joelle Nadle, MPH , California Emerging Infections Program, Oakland, CA
Melinda Neuhauser, PharmD, MPH , Centers for Disease Control and Prevention, Atlanta, GA
Lewis Perry, RN, MPH , Georgia Emerging Infections Program, Atlanta, GA
Jean Rainbow, RN, MPH , Minnesota Department of Health, Saint Paul, MN
Susan M. Ray, MD , Emory University School of Medicine, Atlanta, GA
Arthur Reingold, MD , University of Berkeley, Berkeley, CA
Richard Rodriguez, MPH , Connecticut Department of Public Health, Hartford, CT
Rebecca Smith, MPH , University of Rochester, Rochester, NY
Arjun Srinivasan, MD , Centers for Disease Control and Prevention, Atlanta, GA
Ann Thomas, MD , Oregon Department of Human Services, Portland, OR
Deborah Thompson, MD, MSPH, FACPM , New Mexico Department of Health, Santa Fe, NM
Nancy White, RN , Georgia Emerging Infections Program, Atlanta, GA
Lucy Wilson, MD, ScM , Maryland Department of Health and Mental Hygiene, Baltimore, MD
Scott K. Fridkin, MD , Centers for Disease Control and Prevention, Atlanta, GA

Background: Central line-associated bloodstream infections (CLABSI) and surgical site infections (SSI) as defined by and reported to CDC's National Healthcare Safety Network (NHSN) have been added to the Centers for Medicare and Medicaid Services' new pay-for-reporting requirements. These healthcare-associated infections (HAIs) are largely preventable but may represent a small fraction of all HAIs. CDC's HAI and antimicrobial use prevalence survey will complement NHSN data and fill knowledge gaps by addressing all HAI types and antimicrobial use throughout acute-care hospitals. In 2010, a preliminary survey was conducted with CDC's Emerging Infections Program (EIP).

Objective: To determine HAI and antimicrobial use prevalence in a sample of acute-care inpatients in 10 EIP sites (CA, CO, CT, GA, MD, MN, NM, NY, OR, TN) and refine methods for a 2011 full-scale survey.

Methods: One to 3 hospitals in each site voluntarily participated. Hospital personnel performed the survey on 1 day, collecting demographic, device and antimicrobial use data on a random sample of patients. EIP staff reviewed medical records of patients identified by hospital personnel as being on antimicrobials to collect antimicrobial data and assess for active HAIs using NHSN definitions. Data collection and entry into a web-based data management system was completed in 12/2010. Descriptive statistics were calculated using OpenEpi 2.3.1 and SAS 9.2.

Results: 2015 patients in 22 hospitals were surveyed; there were 136 HAIs (Table) for a prevalence of 6.8% (95% CI: 5.77.9%). Pneumonia (PNEU, 32.3%) and SSI (20.6%) were the most prevalent HAIs; only 6.6% were CLABSIs. Staphylococcus aureus (SA) was the most common pathogen (29/136, 21.3%); 44.8% of SA isolates were methicillin-resistant. Antimicrobial use prevalence was 48.3% (95% CI: 46.250.5%). In 731 patients receiving treatment for active infection, vancomycin (218, 29.8%) and piperacillin/tazobactam (139, 19.0%) were the most commonly administered antimicrobials.

Conclusions: HAI prevalence in this survey was similar to a 2009 single-city pilot survey as well as previously published CDC analyses, and broad-spectrum antibiotic use was common. Our data suggest that initiatives focusing on CLABSI and SSI surveillance and reporting may address only about a quarter of HAIs in U.S. hospitals. Prevalence surveys may provide information useful for targeting surveillance and prevention efforts. A full-scale survey in a large sample of U.S. acute care inpatients is planned for 2011.

Table: HAI distribution (N=136).

HAI

N (%)

Device associated, N (%)

PNEU

44 (32.3)

21 (47.7)

SSI

28 (20.6)

-

Gastrointestinal infection*

17 (12.5)

-

BSI

16 (11.8)

9 (56.3)

Urinary tract infection

16 (11.8)

12 (75.0)

Lower respiratory infection

5 (3.7)

-

Skin/soft tissue infection

4 (2.9)

-

Eye/ear/nose/throat infection

3 (2.2)

-

Other

3 (2.2)

-

*Includes Clostridium difficile